comment: Whatever lies behind Homa's resignation, the signs are ominous

Published: 17/04/2003, Volume II3, No. 5851 Page 17

The honeymoon is over. Dr Peter Homa's resignation from the Commission for Healthcare Audit and Inspection marks the moment when it became crystal clear that the new inspectorate is going to go its own way (news, pages 5-7).

The official line is that Dr Homa and CHAI chair Professor Sir Ian Kennedy had incompatible working styles. What precisely that means, they would not say. But speculation that Sir Ian, the thinker, was keen to concentrate on the intellectual underpinning of CHAI while Dr Homa, the doer, wanted to get on with building the new organisation, has the ring of truth. Throw in the awkward situation created by a highprofile, virtually full-time chair and a chief inspector who believed his role was the equal of that of the NHS chief executive and there is plenty of scope for disagreement.

However, the claim that there was 'no policy difference' between the two men is hard to believe. At the very least, there appears to be disagreement over how much of a new start CHAI needs to make in establishing its inspection regime.

But even taking all this into account, it is difficult to see how we got here. Dr Homa's appointment process was apparently a thorough one - with plenty of opportunities to test these issues. That it failed to do so - and then that these two highly respected and experienced men fell out within just a few weeks - beggars belief.

What now? CHAI's corporate governance arrangements must be reviewed. Health secretary Alan Milburn wanted a strong presence in direct charge at the top of the organisation, but elsewhere in Richmond House concerns are growing that this may present significant problems in the management of the new organisation. There is also a question mark over Sir Ian's accountability - which is fine for a traditional nonexecutive chair, but does not appear sufficiently robust for such a hands-on role.

The recruitment process must also be overhauled. Having failed so spectacularly, CHAI's credibility will not survive another such episode - however high Sir Ian's standing. And the relationship between CHAI and the Commission for Health Improvement needs to carefully monitored. Perhaps this has been too cosy in the past, but open warfare would be far worse - and it would be wrong to underestimate the anger felt within CHI and by its many supporters.

Recently, Sir Ian has formed a close alliance with Audit Commission chair James Strachan - a welcome sign. Strange, then, that a senior HSJ source should report that the brief for the commission's new health director is to 'win back' ground lost to CHAI. The consensus that was developing around the future of health inspection appears to be fracturing. This may be the result of it being subjected to the necessary scrutiny, and the loss of Dr Homa may be a price worth paying - but they are very big may bes.